AB1034 FRACTURE RISK BY FRAX WITH AND WITHOUT BONE MINERAL DENSITY, COMPARISON OF FACTORS AFFECTING CONCORDANCE
Authors: A. Y. Lujano Negrete, C. M. Skinner Taylor, L. Pérez Barbosa, M. C. Rodriguez-Ruiz, A. Aguilar-Leal, L. G. Espinosa Banuelos, A. Cárdenas, D. Á. Galarza-Delgado
Journal: Annals of the Rheumatic Diseases (2022)

Background The Fracture Risk Assessment Tool (FRAX) estimates the 10-year probability of hip (FXC) and major osteoporotic (FXOM) fractures in patients aged 40 to 90 years using important clinical factors, such as bone mineral density (BMD), optional input variables. (1) There is convincing evidence that with or without the use of BMD it provides a well-validated instrument and may be useful in clinical practice for identifying patients at high risk of fracture and informing treatment decisions. (2) Objectives This study aims to determine the concordance between the treatment decision, calculated using FRAX scores with and without BMD, and to identify the risk factors associated with the discordance in patients with autoimmune rheumatic diseases. Methods A cross-sectional study was carried out in patients with autoimmune rheumatic diseases who had undergone osteoporosis detection (OP) using dual bone densitometry in the Rheumatology service of the University Hospital “Dr. José Eleuterio González” during the period August 2020 - August 2021. The FRAX questionnaire was applied to determine risk factors for OP and the results of the instrument with and without BMD were calculated, the patients were classified as low, intermediate, and high risk. A Student’s t-test, a Wilcoxon rank-sum test, and a Chi-square or Fisher’s exact test were used to compare variables between groups and calculate P-values. Results A total of 88 patients were included. Based on FRAX questionnaire responses, 82 (93.18%) patients had at least one risk factor for OP. The FRAX result with or without densitometry resulted in a treatment decision in 48 (54.5%) and 28 (31.8%) patients, respectively. The results were concordant in 65 (73.9%) of the cases. It was found that patients with osteopenia due to BMD had a greater agreement between both measurements (93.3%, p 0.003) than patients with normal BMD (62.5% p 0.001). Likewise, patients with secondary osteoporosis had lower concordance than patients without this diagnosis (25% and 72.5%, respectively, p 0.006). Conclusion The results of FRAX with and without densitometry were mostly agreeable in predicting the need for treatment according to the 10-year probability of hip fracture, however, this concordance decreased in patients with a previous diagnosis of secondary osteoporosis, no significant difference was found between the risk factors for the concordant and discordant groups. More studies are required to determine the variables that cause a decrease in the concordance of the tests. Table 1. Factors that affect the results between the discordant groups. Variables Concordant n=65 No concordant n=23 P value Sex (%) 0.078 Men 8 (12.3%) 0 (0%) Women 57 (87.7%) 23 (100%) Age (years) 57.85 ± (11.66) 59.2 ± (8.36) 0.13 &lt;50 12 (18.4%) 4 (17.3%) 50-59 24 (36.9%) 8 (34.6%) 60-69 17 (26.1%) 9 (39.1%) 70-79 10 (15.3%) 2 (8.7%) &gt;80 2 (3%) 0 (0%) Height (meters) 1.52 ± (0.08) 1.52 ± (1.06) 0.042 Weight (kilograms) 68.5 (59.5-80.5) 68 (64-74) BMI (kg/m 2 ) 28.2 (24.9-33.1) 30.9 (29.2-32.5) 0.002 Normal weight (%) 16 (24.6%) 3 (13%) 0.136 Overweight (%) 22 (33.8%) 5 (21.7%) 0.150 Obesity (%) 27 (41.5%) 15 (65.2%) 0.051 Normal BMD 35 (53.84%) 21 (93%) 0.001 Osteopenia 28 (43.07%) 2 (8.69%) 0.003 Osteoporosis 2 (3.07%) 0 (0%) 0.395 With BMD Without BMD Hip Fracture FRAX Score 5.3 (3.62-9.77) 1 (0.42-2.67) Major osteoporotic fracture 6.2 (4.02-9.85) 0.75 (0.3-1.77) Treatment suggested by FRAX 48 (54.5%) 28 (31.8%) BMI= Body mass index, BMD= Bone mineral density, FRAX= Fracture risk assessment tool References [1]Teeratakulpisarn N, Charoensri S, Theerakulpisut D, Pongchaiyakul C. FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais. Archives of Osteoporosis. 2021 Feb 26;16(1). [2]Horta-Baas G, Pérez Bolde-Hernández A, Pérez-Pérez A, Vergara-Sánchez I, Romero-Figueroa M del S. Concordancia del FRAX México con y sin el valor de la densidad mineral ósea en la evaluación del riesgo de fractura en la práctica clínica diaria. Medicina Clínica. 2017 May;148(9):387–93. Disclosure of Interests None declared